First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, Japan.
Department of Emergency Medicine, Kansai Medical University Medical Center, Japan.
J Infect Chemother. 2022 May;28(5):718-721. doi: 10.1016/j.jiac.2022.02.005. Epub 2022 Feb 10.
The Japanese Respiratory Society (JRS) scoring system is a useful tool for identifying Mycoplasma pneumoniae pneumonia. Most COVID-19 pneumonia in non-elderly patients (aged <60 years) are classified as atypical pneumonia using the JRS scoring system. We evaluated whether physicians could distinguish between COVID-19 pneumonia and M. pneumoniae pneumonia using chest computed tomography (CT) findings. In addition, we investigated chest CT findings if there is a difference between the variant and non-variant strain.
This study was conducted at five institutions and assessed a total of 823 patients with COVID-19 pneumonia (335 had lineage B.1.1.7.) and 100 patients with M. pneumoniae pneumonia.
In COVID-19 pneumonia, at the first CT examination, peripheral, bilateral ground-glass opacity (GGO) with or without consolidation or crazy-paving pattern was observed frequently. GGO frequently had a round morphology (39.2%). No differences were observed in the radiological findings between the non-B.1.1.7 groups and B.1.1.7 groups. The frequency of pleural effusion, lymphadenopathy, bronchial wall thickening and nodules (tree-in-bud and centrilobular) was low. In contrast to COVID-19 pneumonia, bronchial wall thickening (84%) was observed most frequently, followed by nodules (81%) in M. pneumoniae pneumonia. These findings were significantly higher in M. pneumoniae pneumonia than COVID-19 pneumonia.
Our results demonstrated that a combination of the JRS scoring system and chest CT findings is useful for the rapid presumptive diagnosis of COVID-19 pneumonia in patients aged <60 years. However, this clinical and radiographic diagnosis is not adapted to elderly people.
日本呼吸学会（JRS）评分系统是识别肺炎支原体肺炎的有用工具。大多数非老年患者（<60 岁）的 COVID-19 肺炎使用 JRS 评分系统归类为非典型肺炎。我们评估了医生是否可以使用胸部计算机断层扫描（CT）结果来区分 COVID-19 肺炎和肺炎支原体肺炎。此外，如果变异株和非变异株之间存在差异，我们还研究了胸部 CT 结果。
本研究在五家机构进行，共评估了 823 例 COVID-19 肺炎患者（335 例为 B.1.1.7 谱系）和 100 例肺炎支原体肺炎患者。
在 COVID-19 肺炎中，在第一次 CT 检查中，常观察到外周性、双侧磨玻璃影（GGO）伴或不伴实变或铺路石样改变。GGO 常呈圆形形态（39.2%）。在非 B.1.1.7 组和 B.1.1.7 组之间，影像学结果无差异。胸腔积液、淋巴结肿大、支气管壁增厚和结节（树芽征和细支气管中心结节）的发生率较低。与 COVID-19 肺炎相比，肺炎支原体肺炎最常观察到支气管壁增厚（84%），其次是结节（81%）。这些发现明显高于 COVID-19 肺炎。
我们的结果表明，JRS 评分系统和胸部 CT 结果的结合可用于快速推定<60 岁患者的 COVID-19 肺炎。然而，这种临床和影像学诊断不适用于老年人。
